Forms

User security and confidentiality agreement for the New Mexico Statewide Immunization Information System.

Participant organization security and confidentiality agreement for the New Mexico Statewide Immunization Information System.

This form is used by a patient/parent/legal guardian to remove records from the New Mexico Statewide Immunization Information System.

This form is used by a patient/parent/legal guardian to decline to participate in the New Mexico Statewide Immunization Information System.

This form should be used as Consent for COVID-19 Vaccinations

This form should be used to report out of range temperature incidents and submit a troubleshooting record to the vaccines for children program.

County: Bernalillo

Colfax, Guadalupe, Harding, Los Alamos, Mora, Rio Arriba, San Miguel, Santa Fe, Taos, and Union

Cibola, McKinley, San Juan, Sandoval, Torrance, and Valencia

Chaves, Curry, DeBaca, Lincoln, and Quay

Eddy, Lea, Lincoln, and Roosevelt

Catron, Dona Ana, Grant, Hidalgo, Luna, Otero, Sierra, and Socorro

VaxViewNM Demographic and Contact Information Form

This form may be used by individuals requesting a religious or medical exemption to immunization for their children whom attend any public, private or parochial pre-school, kindergarten, elementary, secondary school, or home school and for children attending daycare of childcare facilities.

Certificate of Exemption FAQ

This form may be used by individuals requesting a religious or medical exemption to immunization for their children whom attend any public, private or parochial pre-school, kindergarten, elementary, secondary school, or home school and for children attending daycare of childcare facilities.

Complete this log when transporting vaccines to an alternate or back-up refrigerator, or when transferring to another provider.

The New Mexico VFC Program requires each practice to develop and maintain an Emergency Vaccine Management Plan. Properly completing this template will meet the VFC Program requirement to have a written plan for storage and handling procedures in an emergency.

The New Mexico VFC Program requires each practice to develop and maintain a Routine Vaccine Management Plan. Properly completing this template will meet the VFC Program requirement for VFC Program participants to have written vaccine storage and handling plans.

This form may be used by adult patients aged 19 and older to provide vaccination consent to a healthcare provider.

Adultos Vacuna Formulario de Consentimiento

This form allows you to provide immunization information for entry into NMSIIS.

VFC Vacuna Forma Administración (Parte B)